Manual therapy versus therapeutic exercise in non-specific chronic neck pain: a randomized controlled trial

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Abstract

Background

Nonspecific chronic neck pain is a fairly common disorder that causes a great impact, and it is greatly influenced by psychosocial factors. Among a number of treatment modalities described for its management, the most common approach is based on manual therapy and specific therapeutic exercise, which have shown a moderate effect on subjects with chronic non-specific neck pain. However, the effect times of these treatments have not been accurately detailed. Our study aims to break down and compare the effects of two experimental treatments based on manual therapy and therapeutic exercise.

Methods

The short-term and mid-term changes produced by different therapies on subjects with non-specific chronic neck pain were studied. The sample was randomized divided into three groups: manual therapy, therapeutic exercise, and placebo. As dependent variables of our research, we studied (a) pain, based on the visual analog scale and the pressure pain threshold, and (b) cervical disability, through the Neck Disability Index (NDI). Outcomes were registered on week 1, week 4, and week 12. The findings were analyzed statistically considering a 5% significance level ( P ≤ 0.05).

Results

No statistically significant differences ( P 0.05) were obtained between the experimental groups, if they exist against the control group. Nonetheless, we found that manual therapy improved perceived pain before than therapeutic exercise, while therapeutic exercise reduced cervical disability before than manual therapy. Effect size ( R ²) shows medium and large effects for both experimental treatments.

Conclusion

There are no differences between groups in short and medium terms. Manual therapy achieves a faster reduction in pain perception than therapeutic exercise. Therapeutic exercise reduces disability faster than manual therapy. Clinical improvement could potentially be influenced by central processes.

Trial registration

Brazilian Clinical Trial Registry, RBR-2vj7sw. Registered on 28 November 2018.

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Most cited references 23

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The validation of visual analogue scales as ratio scale measures for chronic and experimental pain.

D. Price, A Rafii, Colman McGrath … (1983)

Visual analogue scales (VAS) of sensory intensity and affective magnitude were validated as ratio scale measures for both chronic and experimental pain. Chronic pain patients and healthy volunteers made VAS sensory and affective responses to 6 noxious thermal stimuli (43, 45, 47, 48, 49 and 51 degrees C) applied for 5 sec to the forearm by a contact thermode. Sensory VAS and affective VAS responses to these temperatures yielded power functions with exponents 2.1 and 3.8, respectively; these functions were similar for pain patients and for volunteers. The power functions were predictive of estimated ratios of sensation or affect produced by pairs of standard temperatures (e.g. 47 and 49 degrees C), thereby providing direct evidence for ratio scaling properties of VAS. Vas sensory intensity responses to experimental pain, VAS sensory intensity responses to different levels of chronic pain, and direct temperature (experimental pain) matches to 3 levels of chronic pain were all internally consistent, thereby demonstrating the valid use of VAS for the measurement of and comparison between chronic pain and experimental heat pain.

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Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association.

John Childs, Joshua Cleland, James M Elliott … (2008)

The Orthopaedic Section of the American Physical Therapy Association presents this second set of clinical practice guidelines on neck pain, linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) prognosis, (3) interventions provided by physical therapists, and (4) assessment of outcome for common musculoskeletal disorders.

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Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters.

Linda Chesterton, Julius Sim, Christine Wright … (2015)

To evaluate interrater reliability using 5 newly trained observers in the assessment of pressure pain threshold (PPT) using a fixed-angle algometer. The study design comprised 2 phases. Phase 1: 5 undergraduate physical therapists were trained in algometry at a predefined angle, at a rate of 5 Newtons (N)/s, to the first dorsal interosseous muscle. Each observer then underwent a competency test of the application speed. The aim was to achieve repeated applications at 5 N/s without visual feedback from the algometer. Phase 2: the 5 observers measured PPT of 13 healthy volunteers, at the first dorsal interosseous muscle. The sequence of observer measurements for each participant was randomized. Mean PPT values for each observer were analyzed using repeated measures analysis of variance, intraclass correlation coefficient (ICC2,1), and standard error of measurement, with 95% confidence intervals (CIs). No significant differences between observers' mean values were found (P=0.094), suggesting no bias. The ICC was 0.91 (95% CI 0.82, 0.97). The standard error of measurement value was 6.27 N/cm (95% CI 5.35, 7.59). Differences in PPT measurements of more than 17.39 N/cm (1.77 kg/cm) are likely to exceed the magnitude of measurement error, and could be used to indicate true change. This margin of error is, however, somewhat larger than a previously proposed minimum clinically important difference in PPT of 14.71 N/cm (1.5 kg/cm). This study provides new evidence that trained observers can apply an algometer at a consistent rate and provide highly reliable measures of PPT in healthy humans, when PPT is calculated as the mean of 3 trials.

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Author and article information

Contributors

Carlos Bernal-Utrera:

ORCID: http://orcid.org/0000-0002-6235-8353

cbernal495@gmail.com

Journal

Journal ID (nlm-ta): Trials

Journal ID (iso-abbrev): Trials

Title: Trials

Publisher: BioMed Central (London )

ISSN (Electronic): 1745-6215

Publication date (Electronic): 28 July 2020

Publication date PMC-release: 28 July 2020

Publication date Collection: 2020

Volume: 21

Electronic Location Identifier: 682

Affiliations

[1 ]GRID grid.9224.d, ISNI 0000 0001 2168 1229, Doctoral Program in Health Sciences, , University of Seville, ; Seville, Spain

[2 ]Fisiosur I+D Research Institute, Garrucha, Almería Spain

[3 ]GRID grid.28020.38, ISNI 0000000101969356, Department Nursing, Physiotherapy and Medicine, , University of Almeria, ; Almeria, Spain

[4 ]GRID grid.6572.6, ISNI 0000 0004 1936 7486, Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), School of Sport, Exercise and Rehabilitation Sciences, , University of Birmingham, ; Birmingham, UK

[5 ]Clinic San Vicente, Madrid, Spain

[6 ]GRID grid.9224.d, ISNI 0000 0001 2168 1229, Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, , University of Seville, ; Seville, Spain

Author information

Carlos Bernal-Utrera http://orcid.org/0000-0002-6235-8353

Article

Publisher ID: 4610

DOI: 10.1186/s13063-020-04610-w

PMC ID: 7385865

PubMed ID: 32723399

SO-VID: f4bcb322-7c98-448c-b113-78a1ef6d3d70

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 18 December 2019

Date accepted : 15 July 2020

Custom metadata

ScienceOpen disciplines: Medicine

Keywords: neck pain,chronic pain,exercise therapy,musculoskeletal manipulations,physical therapy specialty,randomized controlled trial

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ScienceOpen disciplines: Medicine

Keywords: neck pain, chronic pain, exercise therapy, musculoskeletal manipulations, physical therapy specialty, randomized controlled trial

Manual therapy versus therapeutic exercise in non-specific chronic neck pain: a randomized controlled trial

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Abstract

Background

Methods

Results

Conclusion

Trial registration

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Negative Pressure Wound Therapy

Most cited references 23

The validation of visual analogue scales as ratio scale measures for chronic and experimental pain.

Neck pain: Clinical practice guidelines linked to the International Classification of Functioning, Disability, and Health from the Orthopedic Section of the American Physical Therapy Association.

Interrater reliability of algometry in measuring pressure pain thresholds in healthy humans, using multiple raters.

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